Die Pathophysiologie von Endometriose und Adenomyose. Morphologische, funktionelle und molekularbiologische Grundlagen

Zusammenfassung Ätiölogie und Pathogenese der Endometriose sind seit ihrer Erstbeschreibung bis heute Gegenstand intensiver wissenschaftlicher Forschung. Die von John. A. Sampson (1921) entwickelte Theorie der intraperitonealen Dissemination von endometrialem Gewebe durch retrograde Menstruation stellt heute die vorherrschende Sicht der Pathophysiologie der Endometriose dar, wie sie auch von einflussreichen wissenschaftlichen Gesellschaften, wie der Amercain Society of Reproductive Medicine (ASRM) und der European Society of Human Reproduction (ESHRE) vertreten wird. Sampsons Theorie hatte de facto die Trennung von pelviner Endometriose und uteriner Adenomyose in verschiedene Krankheitsbilder ohne gemeinsame Pathophysiologie zur Folge. Ursache war zunächst der Tatbestand, dass das gemeinsame Vorkommen von pelviner Endometriose und uteriner Adenomyose, ein Faktum, das durch unzählige Eingriffe und histologische Aufarbeitung des Operationsmaterials führender Kliniker und Gynäkopathologen als absolut gesichert galt, nicht mit der Sampsonschen Theorie kompatibel war. Er behalf sich mit der Auffassung, dass die uterine Adenomyose, die er als »interne Endometriose« bezeichnete, die Folge von vaskulärer Transmission sei. Obwohl sich seine Terminologie schnell international einbürgerte, konnte sich die Theorie auf Grund schwerwiegender Gegenargumente anfänglich nur schwer durchsetzen. Eine deutliche Akzeptanz erlangte seine Theorie allerdings erst dann, als die Laparoskopie zunächst als diagnostische und sehr schnell auch als operative Behandlungsmethode eingeführt wurde. Dem Operateur präsentierten sich im Wesentlichen nur noch die peritonealen Herde, während sich der Uterus zwangsläufig einer genauen Analyse entzog. Damit war die Möglichkeit einer systematischen klinischen Fehlbeurteilung (clinical bias) gegeben. Während die altvorderen Lehrmeister unseres Faches wahrscheinlich nur schwerwiegende Fälle operierten und sich ihnen oft das Vollbild der Erkrankung bot, präsentierten sich nunmehr, z. B. im Rahmen einer Sterilitätsdiagnostik oder Abklärung von Schmerzzuständen, vermehrt Frühfälle. Hinzu kam eine unvollständige Sicht der Histomorphologie. Gängige Meinung war, dass die pelvine Endometriose im Wesentlichen nur aus endometrialen Drüsen und Stroma bestünde, während die Adenomyose zusätzlich und vorwiegend durch die fibromuskuläre Komponente charakterisiert sei, die, da sie auch bei der tief infiltrierenden Endometriose vorhanden ist, dort zwangsläufig als proliferative Reaktion des umgebenden Gewebes angesehen wurde. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Preview Unable to display preview. Download preview PDF. 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Morphologische, funktionelle und molekularbiologische Grundlagen. In: 125 Jahre Deutsche Gesellschaft für Gynäkologie und Geburtshilfe. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-15012-8_9 Download citation DOI: https://doi.org/10.1007/978-3-642-15012-8_9 Publisher Name: Springer, Berlin, Heidelberg Print ISBN: 978-3-642-15011-1 Online ISBN: 978-3-642-15012-8 eBook Packages: Medicine (German Language)